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L i <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g r; <br /> APPLICATION FOR LAND USE PERMITS <br /> OWNER W 11 II lTELEPHONE <br /> MAILING ADDRESS0 — <br /> oZ l r v e2 �1 Lc e e� luU\_'z�r 1- Mtl,sfl <br /> l <br /> PROPERTY ADDRESSQ5 7 <br /> LEGAL DESCRIPTION 4V/1 (AfL\T <br /> TYPE OF PERMIT(S): SINGLE-FAMILY DWELLING ADDITION DECK CI S�ARAGE/ACCESSORY STRUCTURE <br /> BUNKHOUSE 59.692(1V)GAZEBO STAIRS FILLING/GRADING CAMPING UNIT <br /> COMMERCIAL BUILDING COMMERCIAL AD/DII�{T`ION �CO,MOMS IAL ACCESSORY STRUCTURE ' <br /> STRUCTURE/ADDITION USE: 3a r A -rI V I e Iu ��C' I� <br /> Home/Cabin; Commercial)Business; Bedroom, ark; etc.) U <br /> BUILDING CONTRACTOR: <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8'h X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) = 4 <br /> j <br /> I. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR <br /> S/DRAWN RE SCALE. — n <br /> 2. SHOW THE/LOCATIONSTRUCTU AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES(EB)AND ALL NEW 3 <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, O <br /> AND INDICATE NORTH (F). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TOR ALL LOT LINES, TE BUILDING(S) Q <br /> TO CENTERLINE , ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK = IV <br /> (OHWM)OF LAKE, STREAM OR RIVER AND WETLAND AREAS,AND RA LOT DIMENSIONS. 0' <br /> 4. SHOW THE LOCATION , THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (OFj,AND ALL DISTANCES <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. n <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TOBE GRADED FILLED. <br /> 6. IF SEPARATE PIANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE ? u <br /> PIANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> J w N <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED 50 AN ONSITE VERIFICATION MV BE DONE WHEN �Q Ic ti <br /> NEEDED. CCCGhhh <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> N <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN DAYS OF PERMIT. Cor <br /> 2 A REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER__ _ O <br /> SETBACK AREA. ISD <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> ,Z Inco c' — <br /> J. n g 3 <br /> r .� 3a333 ? = _ <br /> 1 declare Nat this application(Including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief it is true,Correct and Complete. I acknowledge that I am responsible for the detail and become,of all = — _ o- -i <br /> information Contained in this application(Including any accompanying schedule)and I further deCme Mat I recognize Mat this -> 3 <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to Issue a permit I - p <br /> further accept all hablbty,that may be a result a the County of Burrett relying on this Information I am pmvitling in this _ o: — — — S <br /> application. 1 agree to permit county officials charged with administrating county ordinances or other authorized person to have _ BJ — <br /> access to Ne apove4esVlbed premises at any reasonable time for Ne pure a of inspection. <br /> > <br /> OWNER'S SIGNATURE B _ <br /> (date) 3 z <br /> Cu/ <br /> ZONING ADMINISTRATOR_ n r <br /> t c <br /> WNSHIP PERMITS MAY BE REQUIRED a <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE - _ _ <br />